Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders
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Résumé
This is the third European Crohn’s and Colitis Organisation [ECCO] consensus guideline that addresses ulcerative colitis [UC]. It has been drafted by 28 ECCO members from 14 European countries. It is derived from and updates the previous ECCO consensus advice on UC.1–3 All the authors recognise and are grateful to previous ECCO members who contributed to creating the previous consensus guidelines1–6 on which some of the text is based. Attention is also drawn to other ECCO consensus guidelines which have contributed to this endeavour, on extra-intestinal manifestations [EIMs],7 malignancy,8 imaging,9 small bowel endoscopy,10 opportunistic infections [OIs],11 surgery,12 endoscopy,13 pathology,14 anaemia,15 reproduction and pregnancy,16 and paediatric UC.17 The guideline has been condensed into two papers, the first detailing definitions, classification, diagnosis, imaging, pathology, and management of special situations [EIMs, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders of UC]; and the second describing current therapeutic management [treatment of active disease and maintenance of medically induced remission]. The strategy to define consensus was similar to that previously described in other ECCO consensus guidelines [available at www.ecco-ibd.eu]. Briefly, an open call for participants was made, with participants selected by the Guidelines’ Committee of ECCO [known as GuiCom] on the basis of their publication record and a personal statement. Working parties were established to review the consensus statements published in 2012,1–3 after which a recommendation was issued on whether they required revision based upon advances in the published literature. There was agreement that extensive review of histopathology, endoscopy, OI, anaemia, EIMs, surgery, and pregnancy was not required, as these subjects are reviewed in other recent ECCO guidelines7,11–16; rather, abbreviated text and selected statements from these guidelines specific to UC are provided. Paediatric UC is dealt with in a separate ECCO initiative17 which is currently being updated. Provisional ECCO statements and supporting text were written following a comprehensive literature review, then refined following two voting rounds which included national representative participation by ECCO’s 35 member countries. The level of evidence was graded according to the Oxford Centre for Evidence-Based Medicine [www.cebm.net]. The ECCO statements were finalised by the authors at a meeting in Barcelona in October 2015 and represent consensus with agreement of at least 80% of participants. Consensus statements are intended to be read in context with their qualifying comments and not in isolation. The supporting text was then finalised under the direction of each working group leader [FM, FC, AD, PG, FR], including an updated literature search to October 2016 of the most relevant [eight] journals, before being integrated by a consensus leader [MH]. This consensus guideline is pictorially represented within the freely available ECCO e-Guide [http://www.e-guide.ecco-ibd.eu/]. UC is a lifelong disease arising from an interaction between genetic and environmental factors, observed predominantly in developed countries. Its precise aetiology is unknown, and therefore curative medical therapy is not yet available. Within Europe there is an east-west and north-south gradient, but the incidence appears to have increased in southern and eastern countries during recent years.18–20 Patients may live with a considerable symptom burden and high risk of disability21 despite medical treatment.22 Clinicians must advise and treat patients on the basis of currently available information. Despite robust evidence from rigorously conducted randomised trials, the strict and somewhat necessarily restrictive inclusion and exclusion criteria in trial design may limit translation of such evidence to ‘real-world’ patients. Ulcerative colitis [UC] is a chronic inflammatory condition that causes continuous mucosal inflammation of the colon, usually without granulomas on biopsy. It affects the rectum and to a variable extent the colon in a continuous fashion, and is characterised by a relapsing and remitting course.23 Inflammatory bowel disease unclassified [IBDU] is the term best suited for a minority of cases in which a definitive distinction between UC, Crohn’s disease, or other causes of colitis cannot be made after taking into account the history, endoscopic appearance, histopathology of multiple mucosal biopsies, and appropriate radiology.23,24 Indeterminate colitis is a term reserved for pathologists to describe a colectomy specimen with overlapping features of UC and Crohn’s disease.24,25 Detailed information on definitions can be found in Supplementary material, available as Supplementary data at ECCO-JCC online.1,23,24,26–39 Distribution of UC [adapted from Silverberg et al.23]. Disease activity in UC [adapted from Truelove & Witts32]. Montréal classification of disease activity in UC [adapted from Silverberg et and et Disease extent whether therapy and and of It is by the extent at as and extensive colitis of inflammation the management and the of for a therapy in the of or is usually the for and therapy with is appropriate for extensive of colitis the risk of of or cancer and the and the of Patients with extensive colitis have the risk of with have a risk similar to the Patients with colitis an their risk that of patients with extensive colitis as disease patients with and extensive colitis are to have patients with not such It be that the extent at may the extent of disease as with and are to the extent of information and risk for of or colitis may in of patients with Disease and of of disease have not been imaging, and endoscopic including histopathology, on management is as and at of a inflammatory of disease It be to the of active colitis by and before which may causes of that active disease such as mucosal Crohn’s disease, or bowel and patients with active disease including to Patients with an appropriate also have to a from of patients are in at during a a of a relapsing after of Disease activity in the first after to an increased of of active a an was between the to first and the of a the the was patients a for the maintenance of in patients with at patients from to at and from to at in the of described the in patients in the first following of UC between and the most recent the of patients an during the first after was a or within the first but and an activity at least during the first is also UC, a chronic inflammatory was in and were in of patients with an inflammatory after of with who without such an were in with and mucosal The of bowel inflammation is also a risk for in patients with extensive Detailed information on the of can be found in Supplementary material, available as Supplementary data at ECCO-JCC and and are of have been with of The is not as in UC as is in Crohn’s disease for the of disease in colitis have been established for and patients a to following for colitis with to a is for and have been but has been to be to The most are and other such as and have also at has for and of disease a with endoscopic and to can be as a for in patients with inflammatory bowel disease of was with an increased risk of It must be that of these is specific for UC, they represent active with disease there is of The consensus group that the best to define is a of with and mucosal at classification of ulcerative colitis according to at is of as disease has a according to the of is as the for and of patients with UC to have disease and and with All current available for UC have an in with The risk of in patients with UC the of is an in patients with UC, as the risk for The of genetic or is not for the classification of ulcerative colitis Detailed information on can be found in Supplementary material, available as Supplementary data at ECCO-JCC of ulcerative colitis are upon extent and of disease and and and are bowel and colitis UC in and the may be made at small in incidence has been in some after the of UC appears to The inflammation in the rectum and in a and to a variable extent of the colon, or mucosal The extent of inflammation may or but after disease the of inflammation to the extent of previous in the of The that UC continuous inflammation been by of a in and of patients with active UC the of mucosal disease, and may according to disease in for extensive UC from most cases of Patients with active disease also of and patients with usually with and may in UC, or the of Crohn’s The of UC is usually are for or before medical advice is with a in with including and EIMs, in or and may the in of cases and can in of of ulcerative colitis or Crohn’s disease the risk for ulcerative colitis for before and the risk and of UC may to ulcerative colitis of patients with UC have an increased risk of the The risk of UC is in but is also in and of UC as as in of patients with Crohn’s disease in a and the of but may not the of the have a risk of the disease, which is extensive and to with who have or but the data are and during or are to a risk of UC in The of is to that of but not to the of is after the of UC, the on the of disease is and is to may the evidence from and a trial that with is medical the of and and extra-intestinal with and of inflammatory bowel disease or and previous be The of UC is in the context of or of colitis be and be and and for and and may be may be in patients with or disease on on the extent and of of patients with or activity is usually from on Patients with a may and bowel for of ulcerative colitis not It is established by imaging, and endoscopic including be with review after an may be The of UC is characterised by of and of continuous in of the as a by The that of patients a in The of of is usually during the first and may be characterised as continuous UC without or the recent the of patients with UC in from at the of to after of It is to the diagnosis, and of disease, as these and disease It is to the to to a diagnosis, but mucosal active UC as the of of the may to Crohn’s disease or be during the first and and The be including be and be diagnosis, have a inflammatory and and a for is an of of chronic inflammation may be in or The may as a of the chronic inflammatory or chronic active disease, and which the of an UC, and with the of with patients with an is with an and have been as to the for colectomy in after a of extensive colitis an increased risk of is specific to UC from or other causes of be to and for may be according to the medical history, for the of for or other or with are required at and may be required to disease is in patients with colitis This for and is a and has been with and ECCO guidelines with disease be in the of or of can in UC, not in patients with may not disease can or It be in patients who The for relevant in patients with colitis has not been but most of in the inclusion with on histopathology not necessarily but multiple are usually including information on can be reviewed in the ECCO Consensus on and in a recent The most are and are in to of patients with UC and in of patients with Crohn’s the current of these their for the of UC and for therapeutic is not such as and have been as of inflammation in appears to be the most the of in patients for in the of disease with endoscopic and in the of and to with the to between of a in the of UC a to inflammation and to be a to a of patients by and has been described in with a or inflammation in the rectum is to to inflammation in the is to as a and may be observed in patients with the of and or a in of the small bowel in to an is The of patients with inflammation to be similar to with of the as a is in to of patients with inflammation has been with a and a risk of after pouch a recent a similar in patients with an of inflammation with with a in of disease and of or inflammation from the into is and is observed in to of patients with extensive may in patients without which the that that from a of into the Patients with to be to a of which may an increased risk of colon in not to be with pouch of the small bowel be in cases of to UC from Crohn’s bowel by or or endoscopy, as reviewed in the ECCO consensus on in Crohn’s and small bowel in is not is the of an to Crohn’s disease in to an is for endoscopic disease activity in ulcerative colitis are available. The of a endoscopic is to of ulcerative colitis patients and to a for inflammatory bowel disease to is for patients criteria for to which may to increased and The classification of UC was by Truelove and in This classification is to be the for of in of to and the of patients with colitis have inflammatory or and with a for and of be to and to the extent of disease and for features that to The extent of disease with the of in a of the extent of disease was in and in The of mucosal by or two of small bowel is with a to the of colitis and may be required is as a on with high in which histopathology be with a within before is in patients with colitis is not in in patients on criteria for colitis with mucosal on the of these and of which can be by is of is appropriate at for or ulcerative colitis or colectomy Despite the of disease in risk of and of the of after has been a mucosal after of was with a risk of in of the patients with mucosal with of without of patients who endoscopic as a of inflammation at and on during of in to of patients that to endoscopic in patients with UC, who were the disease and endoscopic after and and then at the third were to patients with or between and in the of and colectomy were of mucosal was the with and a disease patients with UC with and in that with endoscopic as with to after patients in The most endoscopic of ulcerative colitis is with of inflammation and ulcerative colitis is by mucosal and at the and in a and The between and is usually and may within in in the endoscopic of disease activity is and have been to the of endoscopic and are within the for UC, which is for trial The Ulcerative Colitis of the and the of and each with or of This is the first endoscopic of in The is the of in the of the colon at the of the a of to the of a a was made to the of the a to a of that the of the from to for ulcerative for The endoscopic features of inflammation are and at least of the active colitis is characterised by a of to the of the and with a and mucosal to colitis is characterised by and in et to Crohn’s disease, in UC are in The of is a disease, mucosal can in of and The of in UC has therefore been the of information on colon can be found in Supplementary material, available as Supplementary data at ECCO-JCC Detailed information on can be found in Supplementary material, available as Supplementary data at ECCO-JCC in ulcerative multiple endoscopic be to by be are not or the is not UC, a an increased risk for and the be by a second is the most in the of and then management in a is to a the mucosal to the and extra-intestinal is for diagnosis, of disease and of and The following and updates of the ECCO guideline on UC is a chronic inflammatory to the of features have been and they can be into mucosal and information on on the can be found in Supplementary material, available as Supplementary data at ECCO-JCC a of ulcerative a of two from at least the colon the and the be be by including endoscopic of disease and current be by in or an before the features found in UC are observed in of patients within of the first of The distinction from colitis which is characterised by and is therefore a is the with the for the of ulcerative colitis and the of a inflammatory not ulcerative colitis at an after an may to and a definitive by features or has been as the with the for UC It can be in of patients within after this the of is but may into a the disease mucosal or mucosal and an or mucosal during the of disease least after The of ulcerative colitis is based upon the of and mucosal and a inflammatory with with active inflammation and The of features for UC has not been of UC is in of cases two or of the following features an and in the of of inflammation from to a of ulcerative colitis may the of of these is in the of from patients to an UC a of continuous inflammation that in the rectum and with a in The between the and the is can disease, the extent of during the of the disease or after may such as from continuous to inflammation of the of these features is to in the of to Crohn’s disease, the may features to and as as of and increased inflammation is usually not observed disease is characterised by the of active mucosal features to chronic mucosal such as and as as may mucosal is characterised by the of and inflammatory the can some features of such as with and of usually the of is from endoscopic mucosal inflammation may in cases with disease and has been with of mucosal inflammation following has been can be to between and active disease, as as to the of disease have been for this in therapeutic of or mucosal a definitions of from inflammation with to of the as in with of an increased with of or a high of been with a risk of The of histopathology to and to the level of inflammation may have in therapeutic mucosal is from endoscopic mucosal have a for diagnosis, with the at and endoscopic activity in and disease, but for The of histopathology as the or to disease activity is in to and may be in and with There and updates of the ECCO guideline on and is in UC, found in of for of et criteria for on the level of patients without or evidence of active disease, is an appropriate the of a to may be with the of or evidence of the criteria for of chronic disease are and the level is between and a of and of chronic disease is The most of in UC are of chronic disease, and a of or anaemia, and are but also be is by the as a in to a of in and in All UC patients be for anaemia, and this a and be with and is with and The level of with and is by the of and in et is in ulcerative colitis patients is Detailed information on and can be found in Supplementary material, available as Supplementary data at ECCO-JCC is the second most in UC, in of can be as and of with ulcerative colitis is based on of inflammation and exclusion of other specific of classification for has been but not is and affects in an This is and and is with disease is a and which affects small is of UC and can for to of is on the basis of features of inflammatory with or features of and The of is made according to the is the current as can inflammation before and The of management is the of of and of trial in patients is of the UC usually within Patients may from and Patients with usually or for symptom for be with a and are to be in with patients with active to or of are The and of and in are The of not as the to the risk of the with not is based on which be in patients with active UC, to or with disease and are the statements to in et Patients on therapy and or with a of be or other as these can statements & in et of is made on a be is usually based on that of the ulcerative are required in cases and can be with or usually affects the of the the and has a It is to disease and is based on that of the are usually or or may be can be with or and or are by a as most on the and to The of with disease activity is are to be the first of has been and has to in therefore be a to is not or are an but advice is to on and inflammation can be found in Supplementary material, available as Supplementary data at ECCO-JCC UC It can be and usually to and of the not to an and may has to UC, is has an and is The of to of to an usually of or or and have each been to be of in cases statements & in et the most condition UC chronic and are also in these patients. of the to treat UC have the to is a risk for and colon is as a in patients with for is and small is a be statements to in et was to the of and to the risk of in but therapy has been to to or the was with a disease and therefore be the of to disease with is the statements to in et or after of in UC patients is in et and in et on and disease can be found in Supplementary material, available as Supplementary data at ECCO-JCC Ulcerative colitis patients at risk of opportunistic infections are with in and with and a of infections be is an risk for opportunistic infections to are according to the for Disease and is as a by a that has under for can be or UC patients are not but may have as a of their medical in et is an risk for and in the risk of in a of for All for the of OI, and the of at a may an increased risk of This risk is of the and of but may be by the of OI, have not been to the risk of All ulcerative colitis patients be for at patients with also be is in patients with ulcerative colitis of is in inflammatory bowel disease, by the disease and by the be after of the may be required to of be in patients at risk and for at least after has patients who are with high to of the of in to of with therapy in ulcerative colitis be but therapy is not is the increased risk of UC patients be to is not a for in et UC patients also be for the be by not a with or is but they can the of in on or can be found in Supplementary material, available as Supplementary data at ECCO-JCC information on and can be found in Supplementary material, available as Supplementary data at ECCO-JCC of in patients with is increased and is in the be by a of history, and according to and national be at and before therapy are to the and are in of is to and be in patients being with with the Patients with therapy before patients with active UC and be after of in et of active therapy must be and for at least in et be to UC patients before and be before can to after & in et UC patients taking who be for infections and UC patients therapy infections with in et active infections are is statements to in et the risk of and infections with in et The to or infections in et therapy be during and disease be before Ulcerative colitis is an risk for with and are in to disease It to be established this to patients with ulcerative be disease, has been to be in patients without ulcerative colitis and is therefore disease, of be by risk and are of is in has been to be in of to and a of to an increased risk for with patients with inflammatory bowel disease are to can be found in Supplementary material, available as Supplementary data at ECCO-JCC There is evidence that ulcerative colitis affects of in with ulcerative colitis the for UC patients are to have similar as the but patients from of as they to not to be by UC can and in et causes and is in patients to a the of are and pouch in patients may to and by to an or in et The in after pouch is to that of subjects in et at a of disease, the risk of is the as in at a of active disease the risk of activity during pregnancy may the of ulcerative colitis Patients be to during to the most appropriate a with and is in et Disease activity at or during pregnancy is with and The risk of in from with ulcerative colitis not to be increased to most ulcerative colitis is of risk to the for and information on of can be found in Supplementary material, available as Supplementary data at ECCO-JCC of ulcerative colitis be in patients who to in to the risk of during pregnancy during pregnancy a high risk of and and are best and without to these UC patients who be to their to disease and pregnancy in et to their during pregnancy, with and be as the a is an in specific situations be in a with for UC during pregnancy can to during the first and to in the third but is to represent a risk for the in et information on endoscopy, and can be found in Supplementary material, available as Supplementary data at ECCO-JCC is that UC is with an increased risk of the risk between et described a including and that after of disease the risk was that the incidence of in UC patients was the risk of may have been has a incidence of at at and at This may the increased of the of that inflammation or the to maintenance therapy or The risk of cancer in ulcerative colitis is increased with the is with disease extent and or inflammatory activity has been that is disease a of may by this in patients who are at colitis or in patients with Patients with extensive colitis the risk of colitis patients an risk is not increased in patients with UC to the without may be an for and a of cancer an risk for cancer The most risk for are an increased risk of to and disease may be of previous inflammatory and have also been found to be a risk of is with an increased the risk
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
La notice
- Revue
- Journal of Crohn s and Colitis
- Thématique
- Microscopic Colitis
- Domaine
- Medicine
- Établissements canadiens
- —
- Organismes subventionnaires
- —
- Mots-clés
- MedicineUlcerative colitisPouchAnal cancerPregnancyColorectal cancerGeneral surgerySurgeryCancerGastroenterologyInternal medicineDisease
- Résumé présent dans OpenAlex
- oui